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General NPI Number Information
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NPI Number | 1861525594
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Entity Type | Individual
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Provider Name | GRACIELA MONICA GARIBALDI PSYD
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Gender | Female
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 06/09/2010
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Provider Practice Location Address
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Address Line | 2200 PACIFIC COAST HWY SUITE 304A
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City | HERMOSA BEACH
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State | CA
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Zip | 90254-2757
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Country | US
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Telephone | 310-968-1949
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Fax |
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Provider Business Mailing Address
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Address Line | 370 CRENSHAW BLVD
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City | TORRANCE
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State | CA
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Zip | 90503-1727
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Country | US
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Telephone | 310-968-1949
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS15506
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License Number State | CA
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